4PC Registration (Step 1 of 4)

Business Information

Pricing

Total Monthly Fee:

One-Time Setup Fee:

Special Notes (Optional)

Terms of Service

4PatientCare Terms of Service

Introduction: This agreement sets forth the terms under which 4PatientCare will provide the above named business (Subscriber) with practice enhancement services. This document constitutes the entire agreement between 4PatientCare and the Subscriber unless amended by a subsequent written, signed agreement between the two parties.

1. The software and authorized use: 4PatientCare will provide the Subscriber with service which may be accessible to the Subscriber’s client through a variety of mediums including but not limited to: email, text messaging, postal and automated telephone. 4PatientCare will host the services on 4PatientCare servers or commercial servers as we may choose.

2. Confidentiality: Neither party to this agreement will reveal confidential information to any third party or to any employees who do not have a “need-to-know” by virtue of their job function. Confidential information shall include, for example, and without limitation, the information entered by the Subscriber for this service. Additionally, all 4PatientCare technical, financial, and marketing information, including system use information provided to the Subscriber, must be treated confidentially

3. Usage by Subscriber: Subscriber may use this service during the Term of this agreement to assist in appointment reminders, confirmations, recalls, web scheduling, order notifications, informational messages, patient surveys and similar activities, provided, however, that the system will not be relied upon for critical messaging, alarms and the like where a system failure could cause costly, fatal or otherwise serious damage or injury. The Parties recognize that computer systems may fail for reasons out of the control of 4PatientCare, including, but not limited to, internet traffic, condition of telephone or cable lines, and condition of Subscriber’s or patient’s equipment. Accordingly, Subscriber agrees that it will backup the data it enters into or is generated by the system and that 4PatientCare is and will not be liable for any loss thereof. The system must also only be utilized for communications that conform to all local, state or federal regulations, including HIPAA and HITECH. The Subscriber recognizes that changes made to their operational environment, including Practice Management System or Electronic Health Record, computer hardware or Operating System or to the 4PatientCare configuration can cause undesired communications or keep communications from going out properly.

4. Patient Privacy: 4PatientCare is committed to keeping your patient’s Protected Health Information (PHI) secure. This commitment allows us to collect and to communicate information used to assist healthcare providers and patients in facilitating better medical care. 4PatientCare complies with all applicable federal and state laws and regulations regarding the privacy and confidentiality of all patient and physician information. In this regard, 4PatientCare's utilization of personal information is limited to that which i necessary to fulfill its mission of assisting physicians in their practice while providing the minimum amount of identifiable patient data required to perform the specified communication. 4PatientCare will not disclose, rent, or sell any personally identifiable patient information to third parties (although 4PatientCare reserves the right to share de-identified, compiled or condensed patient information which does not allow a patient to be identified or contacted). 4PatientCare employs advanced multi-layered encryption and security firewalls to protect confidential information from unauthorized disclosure, misuse, loss, errors or alteration. All information is received and sent under the physician's direction and order via secured encrypted Internet transmission, directly from the healthcare provider’s office. 4PatientCare reserves the right to change this Privacy Policy at any time by posting the new privacy statement at 4PatientCare's Web-Site Homepage: 4PatientCare.com

5. Disclaimer: 4PatientCare does not warrant that this service will meet the needs and purposes of the Subscriber. Additionally, except for refund or credit for fees already paid or due, 4PatientCare specifically disclaims any and all liability for damages of any kind incurred by Subscriber and caused by the use or otherwise related in anyway to 4PatientCare’s systems or services.

6. Proprietary Rights: Subscriber acknowledges and understands that the service software is property of 4PatientCare whose rights are subject to copyrights, trade secrets, patents, and other laws, and that the use of service will give the Subscriber no rights in or to them. This means that Subscriber also agrees that it will not reverse engineer the software, nor will it attempt to do so. 4PatientCare reserves the right to stop providing service to subscriber if it suspects any kind of misuse, abuse, tampering, or other out of the ordinary operations.

7. Taxes: Subscriber will be responsible for any and all taxes, duties and similar cost, imposed upon, due to, or arising from the service.

8. Billing: Upon execution of the agreement, payment for activation and advance payment for one month of services is due from Subscriber. When services are activated, 4PatientCare will bill Subscriber a prorated amount for the first month of usage based on subscribed plan and apply the advance payment to the next month of service. Usage in excess of Subscriber’s plan will be billed in the next billing cycle. Subscriber gives 4PatientCare authorization to process the Subscriber’s card monthly for payment due.

9. Payment: Payment is due upon receipt of invoice. Payment not received within 30 days of the invoice date shall be charged a late fee of $29.95. In addition, there will be an interest charge on any overdue amount equal to the lesser of 1.5% per month or the maximum legal rate. Subscriber shall remain obligated to make all payments due during their current term. Checks returned by the bank for non-sufficient funds will be charged a $25.00 service fee. Credit cards processed and declined over a 30 day period are also subject to a late fee and interest. It is Subscriber’s responsibility to contact 4PatientCare when their credit card information changes and to make sure funds are available.

10. Non-Payment: 4PatientCare reserves the right to shut off Subscriber’s services and submit any unpaid bill to collections after notification of failure to pay and a 30 day grace period.

11. System modifications: 4PatientCare reserves the right to make modifications, enhancements, customizations, improvements, upgrades and/or changes to 4PatientCare’s system and services at any time without advance notice.

12. Indemnification: Subscriber agrees to defend, indemnify and hold harmless 4PatientCare, its officers, directors, employees, representatives and agents from and against any and all claims, demands, actions, causes of action, penalties, judgments and liabilities (including court costs and reasonable attorney’s fees) based upon or arising out of any act, omission, negligence, misconduct or breach of any material condition of this Agreement by Subscriber, or its subcontractors, or their respective officers, directors, employees, representatives and agents. Nothing in this paragraph, however, shall prevent Subscriber from taking action against 4PatientCare for any intentional act by 4PatientCare, its officers, directors, employees, representatives or agents. Subscriber is solely responsible for content they create and choice of who they send communications to with regard to HIPAA and HITECH, federal, State and local laws and regulations. Subscriber specifically agrees to defend and hold harmless 4PatientCare for any issue arising from practice defined content.

13. Dispute Resolution: The Parties agree that if one Party is aggrieved by the actions or inaction of the other Party and/or believes that Party to be in breach of this Agreement, and contacts that other Party with notice thereof, that other Party shall respond promptly (within two weeks) and both Parties will in good faith attempt to resolve the matter, and document the resolution in a mutually signed writing. In the event that the Parties fail to reach agreement within four (4) weeks of the agreement notice (unless mutually extended), arbitration will be entered. Within the purposes and scope of this Agreement, the arbitrator is empowered to determine the extent of his authority, fashion remedies, and order performance. Any decision of the arbitrator shall be binding on the Parties, enforceable by any Court of competent jurisdiction, and only reviewable or otherwise appealable in the case of fraud, collusion, or the like. Costs shall include the arbitrator's fees and costs, and, if held in the county of one Party, the reasonable travel and lodging expenses of the other Party to participate in the arbitration. Fees and costs for participation by either Party's counsel in resolving the dispute (other than in choosing the arbitrator) shall be recoverable only to the extent such participation is authorized or requested by the arbitrator in advance and awarded in his decision. The provisions of this Agreement shall be construed and enforced in accordance with the internal law of the State of California. Costs of arbitration will be borne equally unless the arbitrator chooses to allocate them otherwise in the interests of fairness.

14. Termination and Renewal: Unless otherwise described elsewhere in this agreement, the first term of the agreement is one year from the date the agreement is signed. This agreement will automatically renew for additional terms annually from the date the agreement was signed, with the renewal terms equal in length to the first term. In order to terminate this agreements auto renewal feature in any and all terms Subscriber must give 4PatientCare a written notice 60 days in advance of the renewal date. The renewal date is defined as the date the agreement was signed. A written 60 day notice will keep the agreement from renewing for an additional term but the party must finish paying for the remaining months of the current term of the agreement Should the Subscriber fail to pay when due, 4PatientCare may give Subscriber notice of termination effective 5 days after such notice.

15. Additional Responsibilities: Each party shall comply in all material respects with all applicable governmental laws, rules and regulations.

16. Claims: Except as set forth in this section, in no event will, or any third party whose technology is incorporated in or provided with 4PatientCare’s technology, will be liable to anyone for special, collateral, exemplary, indirect, incidental, or consequential damages, whether as a result of tortuous conduct (unless willful or grossly negligent) or breach of warranty of any of the provisions of this agreement even if 4PatientCare has been advised of the possibility of such damages. To the extent that any damages are caused by the technology, 4PatientCare‘s entire liability under any circumstances shall not exceed the lesser of a) actual damages measured by amounts paid to 4PatientCare for services not delivered or b) the total amount paid by Subscriber that month under this agreement. Each Party will defend, indemnify and hold the other harmless from claims of third parties as follows: 4PatientCare for claims of infringement of intellectual property rights; by Subscriber for claims of loss damages or injury due to use, no availability or errors of the service.

17. Pricing: Unless otherwise noted somewhere else in this agreement, Subscriber agrees to pay 4PatientCare by the price tables below. Email, Text, Voice, Web Reputation and Web Scheduling Services can be used for a flat monthly fee, as described below; a one-time setup fee equal to the first month’s payment will also be billed. Additional providers, locations, and services can be provided at any time, subject to the pricing and terms outlined in this agreement. If the subscriber is to use postal services, that will be billed on a per postcard basis based on the “Postcard Price” table below. A minimum of 100 cards a month is required to use postal services. If the Subscriber uses postal services but fails to meet the minimum, Subscriber will be billed for 100 cards at the price stated in the table. Important note: postal prices listed below do not include the price of postage, which will also be billed to the Subscriber at the current rate of postage per card. One-time message “blasts” by email are included as part of services. One-time message “blasts” by text cost $0.10 per text, and by automated voice call cost $0.20 per call. Services can be provided in Spanish as well with a one time setup fee of $50. Subscriber can use the web scheduling service as a standalone product for $99 per provider per month, with a one time activation fee of $99 per provider.

Monthly Subscription Price for Email, Text, Voice and Web Services
(Choose per Location or per Provider)
Pricing subject to change

18. Configuration adjustment pricing:
Additional providers, locations and services can be added at any time, subject to the pricing and terms outlined in this agreement. If the Subscriber wishes to make adjustments to their configuration after the installation has been completed, fees may apply. For any addition of a Provider, Location or Upgraded services; a one time activation fee will be applied which will be equal to the additional monthly cost of services. If a Provider or Location is being removed at the same time a new Provider or Location is being added; the activation fee will reflect the monthly rate after the removal, with the addition of the new service. If the change in monthly cost is lower than $50, then the activation fee is equal to $50 per added Provider and Location; or $50 flat if there is no change in Providers or Locations. For postal services being added, there is a one time activation fee of $99. If more than one unique postcard design is required, a one time activation fee of $50 will apply for each additional unique postcard design beyond the first. Prompt recordings may be adjusted or added at any time at a cost of $50. English and Spanish prompt recordings will be calculated separately. Partner membership discounts apply.

Agree to 4PatientCare Terms of Service*

The foregoing has been read, understood and is agreed to.

HIPAA BAA

Electronic HIPAA Business Associate Agreement between 4PatientCare and Subscriber

The following HIPAA BA Agreement supersedes all prior HIPAA BA Agreements executed between 4PatientCare and Subscriber, with respect to the subject matter hereof.

Introduction

A "business associate" is a person or entity, other than a member of the workforce of a covered entity, who performs functions or activities on behalf of, or provides certain services to, a covered entity that involve access by the business associate to protected health information. A "business associate" also is a subcontractor that creates, receives, maintains, or transmits protected health information on behalf of another business associate. The HIPAA Rules generally require that covered entities and business associates enter into contracts with their business associates to ensure that the business associates will appropriately safeguard protected health information. The business associate contract also serves to clarify and limit, as appropriate, the permissible uses and disclosures of protected health information by the business associate, based on the relationship between the parties and the activities or services being performed by the business associate. A business associate may use or disclose protected health information only as permitted or required by its business associate contract or as required by law. A business associate is directly liable under the HIPAA Rules and subject to civil and, in some cases, criminal penalties for making uses and disclosures of protected health information that are not authorized by its contract or required by law. A business associate also is directly liable and subject to civil penalties for failing to safeguard electronic protected health information in accordance with the HIPAA Security Rule.

A written contract between a covered entity and a business associate must: (1) establish the permitted and required uses and disclosures of protected health information by the business associate; (2) provide that the business associate will not use or further disclose the information other than as permitted or required by the contract or as required by law; (3) require the business associate to implement appropriate safeguards to prevent unauthorized use or disclosure of the information, including implementing requirements of the HIPAA Security Rule with regard to electronic protected health information; (4) require the business associate to report to the covered entity any use or disclosure of the information not provided for by its contract, including incidents that constitute breaches of unsecured protected health information; (5) require the business associate to disclose protected health information as specified in its contract to satisfy a covered entity's obligation with respect to individuals' requests for copies of their protected health information, as well as make available protected health information for amendments (and incorporate any amendments, if required) and accountings; (6) to the extent the business associate is to carry out a covered entity's obligation under the Privacy Rule, require the business associate to comply with the requirements applicable to the obligation; (7) require the business associate to make available to HHS its internal practices, books, and records relating to the use and disclosure of protected health information received from, or created or received by the business associate on behalf of, the covered entity for purposes of HHS determining the covered entity's compliance with the HIPAA Privacy Rule; (8) at termination of the contract, if feasible, require the business associate to return or destroy all protected health information received from, or created or received by the business associate on behalf of, the covered entity; (9) require the business associate to ensure that any subcontractors it may engage on its behalf that will have access to protected health information agree to the same restrictions and conditions that apply to the business associate with respect to such information; and (10) authorize termination of the contract by the covered entity if the business associate violates a material term of the contract. Contracts between business associates and business associates that are subcontractors are subject to these same requirements.

Definitions

Catch-all definition:

The following terms used in this Agreement shall have the same meaning as those terms in the HIPAA Rules: Breach, Data Aggregation, Designated Record Set, Disclosure, Health Care Operations, Individual, Minimum Necessary, Notice of Privacy Practices, Protected Health Information, Required By Law, Secretary, Security Incident, Subcontractor, Unsecured Protected Health Information, and Use.

Specific definitions:

(a) Business Associate. "Business Associate" shall generally have the same meaning as the term "business associate" at 45 CFR 160.103, and in reference to the party to this agreement, shall mean 4PatientCare.
(b) Covered Entity. "Covered Entity" shall generally have the same meaning as the term "covered entity" at 45 CFR 160.103, and in reference to the party to this agreement, shall mean Subscriber
(c) HIPAA Rules. "HIPAA Rules" shall mean the Privacy, Security, Breach Notification, and Enforcement Rules at 45 CFR Part 160 and Part 164.

Obligations and Activities of Business Associate

Business Associate agrees to:

(a) Not use or disclose protected health information other than as permitted or required by the Agreement or as required by law;
(b) Use appropriate safeguards, and comply with Subpart C of 45 CFR Part 164 with respect to electronic protected health information, to prevent use or disclosure of protected health information other than as provided for by the Agreement;
(c) Report to covered entity any use or disclosure of protected health information not provided for by the Agreement of which it becomes aware, including breaches of unsecured protected health information as required at 45 CFR 164.410, and any security incident of which it becomes aware;
(d) In accordance with 45 CFR 164.502(e)(1)(ii) and 164.308(b)(2), if applicable, ensure that any subcontractors that create, receive, maintain, or transmit protected health information on behalf of the business associate agree to the same restrictions, conditions, and requirements that apply to the business associate with respect to such information;
(e) Make available protected health information in a designated record set to the covered entity, individual or the individual's designee as necessary to satisfy covered entity's obligations under 45 CFR 164.524;
(f) Make any amendment(s) to protected health information in a designated record set as directed or agreed to by the covered entity pursuant to 45 CFR 164.526, or take other measures as necessary to satisfy covered entity's obligations under 45 CFR 164.526;
(g) Maintain and make available the information required to provide an accounting of disclosures to the covered entity or individual as necessary to satisfy covered entity's obligations under 45 CFR 164.528;
(h) To the extent the business associate is to carry out one or more of covered entity's obligation(s) under Subpart E of 45 CFR Part 164, comply with the requirements of Subpart E that apply to the covered entity in the performance of such obligation(s); and
(i) Make its internal practices, books, and records available to the Secretary for purposes of determining compliance with the HIPAA Rules.

Permitted Uses and Disclosures by Business Associate

(a) Business associate may only use or disclose protected health information as necessary to perform the services set forth in Service Agreement. The business associate is authorized to use protected health information to de-identify the information in accordance with 45 CFR 164.514(a)-(c).
(b) Business associate may use or disclose protected health information as required by law.
(c) Business associate agrees to make uses and disclosures and requests for protected health information consistent with covered entity's minimum necessary policies and procedures.
(d) Business associate may not use or disclose protected health information in a manner that would violate Subpart E of 45 CFR Part 164.
(e) Business associate may use protected health information for the proper management and administration of the business associate or to carry out the legal responsibilities of the business associate.
(f) Business associate may provide data aggregation services relating to the health care operations of the covered entity.
Provisions for Covered Entity to Inform Business Associate of Privacy Practices and Restrictions
(a) Covered entity shall notify business associate of any limitation(s) in the notice of privacy practices of covered entity under 45 CFR 164.520, to the extent that such limitation may affect business associate's use or disclosure of protected health information.
(b) Covered entity shall notify business associate of any changes in, or revocation of, the permission by an individual to use or disclose his or her protected health information, to the extent that such changes may affect business associate's use or disclosure of protected health information.
(c) Covered entity shall notify business associate of any restriction on the use or disclosure of protected health information that covered entity has agreed to or is required to abide by under 45 CFR 164.522, to the extent that such restriction may affect business associate's use or disclosure of protected health information.

Permissible Requests by Covered Entity

Covered entity shall not request business associate to use or disclose protected health information in any manner that would not be permissible under Subpart E of 45 CFR Part 164 if done by covered entity.

Term and Termination

(a) Term. The Term of this Agreement shall be effective as of the start date of the Covered Entity - Business Associate contract, and shall terminate on termination of said contract.
(b) Termination for Cause. Business associate authorizes termination of this Agreement by covered entity, if covered entity determines business associate has violated a material term of the Agreement and business associate has not cured the breach or ended the violation within the time specified and agreed to by covered entity and Business Associate.
(c) Obligations of Business Associate Upon Termination. Upon termination of this Agreement for any reason, business associate, with respect to protected health information received from covered entity, or created, maintained, or received by business associate on behalf of covered entity, shall continue to use appropriate safeguards and comply with Subpart C of 45 CFR Part 164 with respect to electronic protected health information to prevenuse or disclosure of the protected health information, other than as provided for in this Section, for as long as business associate retains the protected health information.
(d) Survival. The obligations of business associate under this Section shall survive the termination of this Agreement.

Usage by Subscriber

Subscriber may use this service during the Term of all agreements between Subscriber and
4PatientCare to assist in authorized patient communications. The system should not be relied upon for critical communications, alarms and the like where a system failure could cause costly, fatal or otherwise serious damage or injury. The system must also only be utilized for communications that conform with all local, state or federal regulations, including HIPAA and HITECH.

Indemnification

Subscriber agrees to defend, indemnify and hold harmless 4PatientCare, its officers, directors, employees, representatives and agents from and against any and all claims, demands, actions, causes of action, penalties, judgments and liabilities (including court costs and reasonable attorney's fees) based upon or arising out of any act, omission, negligence, misconduct or breach of any material condition of this Agreement by Subscriber, or its subcontractors, or their respective officers, directors, employees, representatives and agents. Nothing in this paragraph, however, shall prevent Subscriber from taking action against 4PatientCare for any intentional act by 4PatientCare, its officers, directors, employees, representatives or agents.

Miscellaneous

(a) Regulatory References. A reference in this Agreement to a section in the HIPAA Rules means the section as in effect or as amended.
(b) Amendment. The Parties agree to take such action as is necessary to amend this Agreement from time to time as is necessary for compliance with the requirements of the HIPAA Rules and any other applicable law.
(c) Interpretation. Any ambiguity in this Agreement shall be interpreted to permit compliance with the HIPAA Rules.

Agree to Electronic HIPAA Business Associate Agreement between 4PatientCare and Subscriber*

Provider Details

Configuration Call

Please choose a date and time to have a call to go over the setup of your services. This call will take approximately one hour.

Ideally, it would be best if everyone (you, your practice manager, front staff, other doctors, etc) could join for the call; having a familiarity with the 4PatientCare system at all levels of your office will allow everything to run more smoothly once we actually go live with services.

Date*

Time*

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